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PubMed2002

A survey of ethical issues surrounding supply of information to members of the public by hospital pharmacy medicines information centres.

OBJECTIVES: To examine ways in which medicines information pharmacists approach ethical dilemmas encountered in information supply, to appreciate the factors affecting any observed variation in responses, and to identify and training deficits among medicines information (MI) pharmacists in this area. METHOD: A questionnaire was circulated to all medicines information pharmacists working in the hospital pharmacy service in the United Kingdom. The survey presented ten realistic scenarios involving requests for information on a variety of topics from 'lay' callers. MAIN OUTCOME MEASURES: Respondents were asked to identify any perceived ethical dilemmas presented by the scenarios and to indicate their preferred replies. Details on training given or received in this area were also requested. RESULTS: The overall response rate was 151 of 286 questionnaires mailed (52.8%), representing 137 discrete DI centres throughout the UK. Postgraduate clinical qualifications were possessed by 71% of respondents. Just 32 (21.2%) indicated that they gave training on ethical issues surrounding information supply while 57 (37.1%) said they had received such training. Over half (54.3%) had neither received nor delivered training on ethical issues. Of the 32 who said they gave training, 21 had received training themselves. Only 4 (2.6%) said they had a protocol in place for dealing with enquiries from members of the public. CONCLUSIONS: There was considerable variation in how respondents thought the scenarios might be resolved, emphasising the varying levels of appreciation of the issues and lack of a uniform approach to management. An interesting dichotomy emerged between liberal and conservative approaches. Liberal pharmacists clearly believed that all MI data is in the public domain and should be produced and evaluated on request because patients have a "right" to it. The conservative pharmacists had a more protective attitude toward the patient and believed that patients should not be given information by MI pharmacists directly; rather that it should be channelled through the patient's doctor. These two approaches are not incompatible, and may be adopted by the same pharmacist at different times. From their observations, the authors propose a basis of an ethical guideline for MI pharmacists.

Confidence Intervals↗
PubMed1984

Description of a skills oriented health ethics program.

Continuing change requires that the primary goal of ethics education be the development of competencies to address changing ethical issues. To develop the skill of critical ethical thinking, a two component model was developed. The first component is a two semester hour course in ethical theory. This component is analogous to the theoretical component of a science curriculum and it emphasizes that ethical theory, like scientific theory, is held hypothetically, subject to revision and replacement as it develops in response to "data." The other component, a one semester hour course in health ethics, is designed as the "laboratory" in which theory interacts with ethical problems in health-care situations. Skill development takes place by requiring students to find and defend solutions to ethical dilemmas by applying and refining ethical theory. the ethical issues addressed include but are not limited to current issues in pharmacy. The ongoing evaluation of this model by external evaluators from the funding agency, local consulting faculty, and students has consistently emphasized the value of concrete involvement in cases concomitantly with the exposure to ethical theory.

Competency-Based Education↗
PubMed1986

Polygraph testing--a comprehensive literature review of an ethical dilemma.

The purpose of this article is to provide pharmacy educators with knowledge regarding the polygraph. These facts are valuable in training and counseling students and are prerequisite to making informed decisions as leaders in the profession. Businesses lose six-billion dollars annually to employee theft. One in four U.S. employers currently use the polygraph on employees, and pharmacists are frequently subject to the procedure. Several U.S. corporations report the lowest loss rates in the industry without resorting to the polygraph. They utilize traditional techniques of security, accounting, and personnel administration. Patterns of nonspecific autonomic responses modified by race, sociability, moral development, interpersonal climate, education, pain, and exercise level, indicate that the procedure is not valid. The procedure yields approximately 11 percent false positive and 2 percent false negative results. No licensure is required in 24 states, and 40 states allow employers to use the technique at will. NACDS and NARD support of the polygraph, while the APHA and the Retail Clerks Union oppose it.

Civil Rights↗
PubMed2006

Ethics committees in Croatia in the healthcare institutions: the first study about their structure and functions, and some reflections on the major issues and problems.

OBJECTIVES: In Croatia, ethics committees are legally required in all healthcare institutions by the Law on the Health Protection. This paper explores for the first time the structure and function of ethics committees in the healthcare institutions in Croatia. DESIGN: Cross-sectional survey of the healthcare institutions (excluding pharmacies and homecare institutions) to identify all ethics committees. SETTING: Croatia six years after the implementation of the Law on the Health Protection. MAIN MEASUREMENTS: Structure and function of ethic committees in the healthcare institutions. RESULTS: 46% of the healthcare institutions in Croatia (excluding pharmacies and homecare institutions) have an ethics committee; 89% of ethics committees have 5 members 3 of whom are from medical professions and 2 come from other fields; 49% of those committees stated that their main function is the analysis of research protocols. Only a small fraction of those ethics committees sent in standing orders, working guidelines or other documents that are connected with their work. CONCLUSIONS: Although there are legal provisions for ethics committees in the healthcare institutions in Croatia, there is an evidence of discrepancies between the practice and the "Law on the Health Protection," suggesting the need for revision of the law. There is a need for creating separate networks of HECs and IRBs in Croatia. In comparison with other countries, the development of ethics committees in Croatia has some similarities with other transitional societies in Europe. Additional research should be undertaken in the work of ethics committees in Croatia in order to understand committees' group dynamics, attitudes, and knowledge.

Croatia↗
PubMed2005

The ethics and economics of consuming Canadian drugs.

Many U.S. citizens are unable to afford prescription medication in their own country, so they purchase them from Canadian pharmacies. This paper examines the ethics of importing drugs from Canada, including economic implications and how physicians should respond to this dilemma. The four basic principles of ethics are balanced by examining financial incentives, current Canadian and U.S. law, safety issues, the burden of research and development, the impact on Canadian physicians, and issues of liability. The paper concludes that the principle of autonomy permits individuals to cross the border and purchase drugs for personal use; however, nonmaleficence prohibits the purchase of these drugs through third parties. In addition, the U.S. government has special obligations to justice and beneficence and may not ethically sponsor the importation of Canadian drugs. Finally, the paper shows that U.S. doctors must not recommend importation on the basis of beneficence and autonomy.

Beneficence↗
PubMed1991

Hospital pharmacy in 1990: the year in review.

The accomplishments of hospital pharmacy in 1990 are reviewed, and external and internal factors affecting the profession are described. Six issues were identified as having a major impact on hospital pharmacy in 1990: cost containment, productivity and leadership, patient safety, medical-legal and ethical considerations, human resource management, and computers and new technologies. Highlights of activity in each of these areas, as reported primarily in the American Journal of Hospital Pharmacy, are reviewed. Hospital pharmacy remains a vibrant and growing profession that is responding positively to external and internal challenges.

Clinical Pharmacy Information Systems↗
PubMed2004

Your client credibility: are your pharmacy practices helping or hindering?

When recommending a specific pharmaceutical, more has to be taken into account than whether the API is indicated for the illness in question. Based on the preceding discussion, product source can have a tremendous impact on efficacy, on therapeutic success, and on practitioners' credibility in the eyes of their clients. However, product source goes beyond simple credibility, encompassing professional ethics and liability. In answering the Ethical question of the month--December 2001 "Should private veterinary practitioners be allowed to produce autogenous vaccines or compound antimicrobial products for use in food producing animals?" Rollin concluded, "one cannot envision a clearer case of unethical behavior." The reality is that quality assurance, efficacy, potency, and safety are not defined for compounded products, and should veterinarians choose to script or dispense one, the responsibility for its quality, efficacy, potency, and safety falls squarely on their shoulders. Ultimately, this also translates into 100% liability should an ADR, illness, or lack of effect, befall the patient. While having access to ELDU and compounded products is crucial in facilitating the treatment of the various diseases that veterinarians face, the regulatory freedom that gives them this choice carries heightened responsibilities when electing this option. In a nutshell, ethical and responsible principles of pharmacy dictate that a veterinarian's first choice should be a veterinary-licensed pharmaceutical for the indication in question. Should this not exist, ELDU of a licensed product with clinically derived therapeutic protocols should be the next choice. Compounded pharmaceuticals should only be used when no licensed (those sporting a DIN) product exists, and extreme cautions should be exercised when using transdermal formulations. Liability dictates that this decision be undertaken with informed consent of the owner and with appropriate due diligence when selecting a compounding service provider. Various articles have been written that provide the veterinarian with guidance when making this decision.

Animal Diseases↗
PubMed1999

Ethics in Christianity and health care: can "character" be defined in this interdisciplinary course?

OBJECTIVE: To describe a unique interdisciplinary ethics course that incorporates elements of character into a decision-making model. METHODS: The Ethics in Christianity and Health Care course is divided into two sections: ethics in Christianity and ethics in health care. The first section comprises the initial 30% of the course, and the second portion spans the latter 70%. Character traits of ethical persons are described in the second section of the course and are then used in an adapted decision-making model. A scenario from a nontraditional Doctor of Pharmacy student is included to illustrate this decision-making process. Texts, assignments, and assessments are also discussed briefly. SUMMARY: This course provides a framework within which ethical relationships are described and discussed. The character traits delineated in the article offer a logical approach when solving ethical dilemmas.

Character↗